Pastoral Report Articles

They come from all over Northern California. Broken, wounded, and scarred, they arrive strapped to a gurney –three, four, sometimes five in a day. Frightened, exhausted, perhaps in physical pain, they often come directly from short stays in ICUs, where for a while they abided in the space between life and death.

Almost all arrive alone, accompanied solely by medical transport personnel. Many will have family members arrive minutes or hours later, to join them. Some arrive with little or no local support and may have few visitors during their stay.

Most speak English but others do not, limited to the use of Spanish, Tagalog, Chinese, and other languages. They are of all ages, races, genders, ethnicities, religions and income levels.

They have suffered strokes, brain tumors, car accidents, amputations, head or spinal cord injuries, and sometimes gunshot wounds. A few have chronic and incurable conditions of the nervous systems.

Upon arrival, almost all are unable to walk, many are unable to talk or have cognitive challenges due to traumatic brain injury. Some cannot swallow food. They are often incontinent.

Welcomed by caring but busy nurses, they are processed into the system. Within a few hours they will be examined by various doctors, therapists and specialized nurses. Within a day their regimen of daily therapies - physical, occupational, speech - will begin as acute rehabilitation - “boot camp” - moves into high gear.

Their stay will be perhaps a week, or up to a month. At some point during their stay, at least once, they and their loved ones will be visited by a hospital chaplain.

The Kaiser Foundation Rehabilitation Center (“KFRC”) is a 50-bed acute rehabilitation facility, a sort of hospital within a hospital, at Kaiser Medical Center in Vallejo, California. Thirty miles northeast of San Francisco, Vallejo is a mid-sized, diverse city– the most diverse city in the United States, according to recent studies.

At first, the KFRC, with its reputation as a premier rehabilitation facility, clean, bright, and cheerful, with large modern patient rooms, a state of the art gymnasium, the latest rehabilitation equipment and facilities and highly trained staff, can feel oddly out of place, more suited for larger cities like San Francisco or New York. Most people may not know that Kaiser Permanente has deep roots in the local community, and that the KFRC has been headquartered in Vallejo for over 70 years.

Today, the KFRC is staffed by (approximately) 30 physical therapists, 20 occupational therapists, 10 speech therapists, nine doctors, seven case managers, 11 administrative personnel, two medical social workers, and one clinical chaplain. For the past six months, that chaplain has been me.

It’s a chaplain’s workday like any other, as I head to Room 302, a large, light filled two-person room, intending to see S., a 75-year-old stroke survivor. S’s bed is empty. She is likely in one of her many therapies. In the other bed lies a much younger woman, flat on her back, alone and unattended. She is not on my list, indicating she arrived within the hour since I printed it.

“Hello. I’m sorry, I didn’t know you were here. You must have just arrived. My name is Peter, and I’m a chaplain serving on this floor. What’s your name?”

As I approach her and reach out my hand, she lifts her own with difficulty. Holding my hand, looking deeply into my eyes, she begins to cry.

“Are you able to speak? She moves her head very slightly from side to side letting me know she can not speak.

“Can you understand what I am saying?” She nods her head ever so slightly.

I pull up a chair to be next to her, looking directly into her tear drenched eyes, leaning closer.

“I need to tell you something important and I hope you can trust I’m telling you the truth.”

Her eyes widen.

“You are safe now. You would not be here unless you were out of danger.”

At these words she begins crying more intensely, and her cries are accompanied by a wordless wailing sound, the only sound she apparently can make given her condition.

“I need to tell you something else”. Her wailing stops, even as her tears continue to flow.

“I don’t know anything about you, who loves you and who is supporting you. But I mean this with all my heart. I love you and I am here for you.”

With this, she begins to wail again, this time louder, deep toned, incredibly mournful, animal like. The sound of inconsolable loneliness and grief.

One of the nurses enters and tries to calm her, “It’s alright, you don’t need to worry.” I gently cut her off. “Let her cry, she needs to and I’m with her.”

For the next 20 minutes I sit with her as she cries. I say to her, “Let it out,” “I feel you must be missing a loved one, maybe your mother,” and other words, not meant as comfort but rather as acknowledgment of what she has lost.

A new nurse comes in, to give her pills and otherwise to attend to her. She stops her crying. I tell her I will see her the next day. What I want to tell her is this: “You are feeling your grief. That grief will take a long time to heal. But tomorrow the healing will begin.”

Unlike chaplains in acute care settings, I have the opportunity to meet with patients and families repeatedly, over two , three or four weeks. While our patients have been severely damaged and have suffered a traumatic event, few are “actively” dying. Most will live lives of normal length. But for many, adapting to their condition – be it a lifetime bound to a wheelchair or walker, or needing assistance in activities of daily living – will be an ongoing process for years and decades to come.

Many arrive with the fantasy that “rehabilitation” means “getting back to the way I was before.” This is not usually the case and whatever their physical and cognitive improvements over time, to me this is a myth, entirely elusive. Their damage is in all cases a defining moment in the arc of patients’ lives and that of their loved ones as well. Phrases like “before Billy had his accident,” “before Dad’s stroke,” “after he had surgery for his brain tumor” are routine in the KFRC. They become the markers of a changed life. The idea of returning to life “before” resembles the denial common to patients and family members as they anticipate or confront death.

The rehab patient and their family members experience, consciously and unconsciously, a deep sense of loss and, with that loss, grief. The person they imagined they were, the narrative of their lives up that point, is over, forever gone, “dead”, never to return. Unlike with the dying, there is also a secondary grief, the loss of the person they imagined they would be and become in the future. Many a patient has told me that they had recently retired and they had this or that plan for the next 20-plus years, the so-called “golden” years, often for travel, exploration, or fulfilling a bucket list of aspirations and dreams. Sometimes just days or weeks before or after this retirement plan and their “new life” is to begin – Bam! – a stroke or other event strikes! Never expected or rarely even imagined, their lives are forever changed.

As with death, if we are to truly move through and transcend its life changing effects it is important in the face of loss to acknowledge grief, to fully experience it, to feel it at its core. The denial of loss – a coping mechanism we often seem to readily embrace – takes a heavy toll, creating limits on our intimate relationships, accompanied by fear and, perhaps worst of all, the “demons” of shame and self-loathing.

Only by accepting and then moving through grief can we fully begin the process of healing. Thus, here at the KFRC, even while those in our care are processing the immediate grief in the loss of their own imagined life story, they have an opportunity to be reborn, to choose who they will be in this new life ahead.

It is the next day and I come to visit the woman again. She again tears up, but this time her eyes suggest a shyness that I interpret to mean a kind of gratitude for my presence and the moment of intimacy we shared the day before. She still cannot speak a word, but her face holds all she needs to say for today.

After speaking to her for a couple of minutes about the busy day she has ahead, I tell her, “I believe that before you leave here you will be able to tell me all about yourself. And I can’t wait to learn who you are and who you hope to become.”

The KFRC is a place of loss, grief and rebirth. Like midwives, we accompany patients through the fear and anticipation of birthing a new life and embracing the challenges, joys, sorrows, and uncertainty that life uniquely holds for them, as it does for each and every one of us.

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Peter Meadow is the Clinical Fellow in Pastoral Care at Kaiser Permanente in Vallejo, California, and currently serves as chaplain to the Kaiser Permanente Rehabilitation Center. He is a member of the Sacramento Chapter of the College of Pastoral Supervision and Psychotherapy.

Twenty years ago, a truck bomb went off outside the Alfred P. Murrah Federal Building in Oklahoma City, Oklahoma, killing 168 people and injuring hundreds. CPSP Chaplain Kenneth Blank talks with Chaplaincy Alive!podcast host, Susan McDougal, about the day of the bombing and the days following that historic event, and discusses how it impacted his life, and the lives of his fellow-chaplains, and the lives of the people living in Oklahoma City.

In his interview with Susan McDougall, Ken Blank mentions a paper he wrote, "Pastoral Care and Response to Disaster - The Oklahoma City Experience", and readers can download the paper by clicking HERE.

I want to thank all those who have volunteered so much of their time performing essential tasks for this community. We have prospered for over a quarter century because of volunteer labor. I especially want to single out, Charles Kirby our Treasurer, Orville Brown, Chair of Annual Chapter Recertification, Perry Miller and his Communications Committee. They are inaugurating a cyber program, Chaplaincy Alive, with Susan McDougal as host. Medicus Rentz has created our first ever Finance Committee, which is analyzing our cash flow and prognosticating our future financial condition. Many of us have toiled away, but none of the rest of us have spent so many uncompensated hours dealing with complex and intractable problems as Cynthia Olson, Chair of the Accreditation Oversight Committee and Jonathan Freeman Chair of Certification. These are huge, complex, and critical tasks and we are grateful to them for their service to us.

After several years of hard work on Accreditation, Cynthia has asked to have the baton passed to someone else. We thank her for hard work, her leadership, and her perpetual good spirit. I don't think I have worked with anyone ever before who has been so immediately available and so consistently of good humor in the face of tough decisions. Cynthia is the real thing. And we will have other more personally rewarding waiting tasks to be put into her hands.

I have appointed Al Henager to succeed Cynthia as Chair of Accreditation. He has agreed and we should all thank him for that. I of course refrained from telling him what he is getting into. But he'll find out soon enough. This job will either make him great or kill him.

I have appointed Francine Hernandez, David Roth, Perry Miller and Jim Degrado to the Plenary Planning Committee, with Degrado as chair. They are currently completing those plans.

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Never before has there been such energy and activity across the community as we have had the last 18 months, which I believe is attributable to our new By-Laws which encourage participation in decision-making and determining the direction of this community.

I want to express my thanks to Bill Scar for his leadership as President. He has put himself into the task with energy and imagination. His innovative occasional Notes to the community have enriched us all. We expect continuing leadership from him as an elder statesman when his term runs out in six months.

I want to thank our only two paid staff, Krista Argiropolis and Charles Hicks. Each of them has carried very heavy loads over the past six months, and their energy and commitment have been instrumental in keeping together as a community.

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I have requested for Charles Hicks to set up the legal framework for a CPSP Publishing House for the publishing of books. The impetus of this is David Roth's stunning acquisition through his own initiative of the publishing rights to Anton Boisen's writings. We expect that the republication of these out-of-print books will be the first thing on the agenda. This will be a huge contribution to the clinical pastoral movement as a whole. The fact that Boisen's books have been out of print for a generation or more is strange phenomenon, and a disgrace. It suggests that pastoral clinicians have stopped reading Boisen, just as Lutherans have stopped reading Luther, and the Methodists have stopped reading Wesley, to their great loss. And with a press in place we can publish other writings as well. Robert Powell's rich works need to be republished in a form that is easy to access. This initiative will have a substantive impact on the entire clinical pastoral field, and enable us to promote our unique philosophy of clinical pastoral work more effectively. And I thank David for moving us in this direction.

I am appointing David Roth as Editor-in-Chief of the CPSP Publishing House, and am appointing as members of the Editorial Board: Charles Hicks, Robert Powell, Perry Miller, Cynthia Olson, Brian Childs, Bill Scar, Francine Hernandez, George Hull, Bill Alberts, Belen Gonzales and David Moss. There will undoubtedly be others who will need to be added to this board as time goes on. The structure and terms of this publishing venture will be worked out later. However, one critical objective is to have the Boisen books in hand in time for the March Plenary.

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Eric Hall, recently appointed President and Chief Executive Officer of HealthCare Chaplaincy Network (HCCN), announced earlier this year that HCCN was creating a new subsidiary organization carrying the label Spiritual Care Association (SCA). The objective of this initiative as we understand it is, among others, that of bringing together the disparate groups in the field of pastoral care and counseling. At the HCI annual gathering in San Diego in the spring, where Eric Hall unveiled the new organization, he approached David Roth and signaled that he wanted a meeting with CPSP leadership, and David communicated that message to me. Subsequently I appointed Perry Miller, Brian Childs, and Charles Hicks to join me in conversations with Eric and members of his staff. We have had several discussions, both in person and electronically.

I think I speak for others on our team in reporting that Eric Hall seems to be the real thing. He is gracious, generous, conciliatory, negotiable, and I believe he understands what CPSP represents and what we are committed to, as well as what we would not want to be involved in.

The introduction of a new player in the larger clinical pastoral movement seems to me to bode well. I have hopes that it will result in more serious conversation and debate in the movement at large, and that this initiative will open more candid and generous conversation in the wider clinical pastoral world. I think I speak for my colleagues who have been in conversation with Eric when I say that. Furthermore, we understand that his principal objective is to create a multi-organizational association. And that seems to us to be a promising direction. While it is not entirely clear what shape all this might take, his vision of a big tent is commendable.

He also proposes that SCA itself certify clinician chaplains. How that initiative will mesh with CPSP is not yet clear. Certainly we can have no objection to his organization offering certification. We have had lengthy discussions with him about his proposed process of certification. And it is noteworthy that Eric listens to us when we have made suggestions and criticisms.

The five of us who have been in conversation with Eric Hall believe that it will serve our interests to build some kind of working alliance with Eric and SCA, and we propose to move in that direction.

We have made no official agreement with him, but we like what he says, what he is, and what he has done thus far.

Perry has pointedly observed that Eric Hall is shaking up the larger clinical pastoral world - the current stalemate - and we certainly cannot be opposed to that. We welcome it. I believe the five of us concur in that regard.

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Someone - I believe it was Santayana - once said that those who do not know history are destined to repeat it. I want to set Eric Hall and the SCA phenomenon in historical context.

Please indulge me for a moment a few words of reflection on history. I think it is relevant.

The encounter of two radically different personalities was the occasion of the creation of the clinical pastoral movement almost a century ago: an egotistic physician and preeminent clinician, Richard Cabot of the Boston Cabots, and a sometime psychotic and dissident Presbyterian/Congregationalist minister, Anton Boisen. Boisen was inspired by his own personal history of psychosis, and later his study of Sigmund Freud's writings, and his inspiration led him to undertake the training of ministers in therapeutic work with disturbed persons. He sought out Cabot to acquire expertise in the clinical method. With Cabot's assistance Boison got off to an impressive start in 1925. He was joined immediately by a psychiatric genius, Helen Flanders Dunbar, and soon by several others. They radically changed theological education forever. In the fifth year of this incipient movement its leaders, in the very same year that they had incorporated, separated into two camps on not-so-friendly terms. In one camp following Anton Boisen was Helen Flanders Dunbar, Carroll Wise and others, who continued to constitute the Council for Clinical Training. In the rebel camp was Richard Cabot, Philip Guiles, Russell Dicks and others, ultimately constituting what in 1944 officially became Institute for Pastoral Care.

As it turned out, against all expectations, (and this is my point) these two competing and philosophically opposed groups enriched each other through trenchant debate for a generation. Once the heat was turned down a little, after a couple of years, their different ways of seeing things and their opposing approaches to training enriched each other, and kept each other honest.

The two groups eventually merged in 1967 to form the ACPE. And the movement has gone downhill since.

My contention is that the period 1930-1967 was the golden age of the clinical pastoral movement. The conversation and competition between the Council and Institute was intense - and not entirely friendly - but ultimately it was respectful, and through the years each group evolved in significant ways. Both groups were held in esteem by the seminaries and the various religious communities. But most importantly, they learned from each other.

I also contend that the merger of the two in 1967 was a error of historic proportions, putting an end to serious dialogue and establishing group-think in its place. And the merger - and the univocal result - prepared the necessity for the emergence of CPSP in 1990.

But CPSP has not succeeded in restoring the dialogue of what I call that golden age, 1930-1967. It has met a wall of resentment over the fact that we broke the unity. The years of 1990 to the present have been years of bitterness over the destruction of the sacred monolith.

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So now comes the wild card, Eric Hall. I propose that he may be able to do what CPSP has not been able to do, bring all parties back into dialogue, with mutual respect and mutual criticism. And criticism is the life blood of any authentic clinician.

Therefore I propose to continue our conversations with Eric Hall and the SCA and to join with them in any way we can as long as our integrity is protected. I emphasize that we are not at the stage of closing any monumental deal, but rather in the beginning of what I see as and certainly hope is a promising courtship. And courtships sometimes have happy endings.

My vision is that of another golden age where serious pastoral clinicians will engage each other critically and with respect, strengthening in the wider community the clinical vocation of pastoral care and counseling. Let's find out, as we move forward with Eric Hall, if my vision is a delusion or a harbinger of great things to come.

Two nieces sent us a dour reflection on winter. Literally slouching toward 87, I wrote an encouraging reply instead of quoting Ecc. 3:1-8. No go. The idea of turning 60 still freaked out Niece 2, who still can't believe another decade has passed. Neither can we. Nor could we have imagined what has occurred since Age 60. It seems just days ago that our daughter met this tall guy -- our long drive West to the wedding; driving through Colorado, and moving here; Chaplain training; and our 60th wedding anniversary.

A witty in-law who lived in these mountains a long time claims our real seasons are Snow, Hot, and Mud. Hmm, Snow on the way! Dig out those boots/togs or buy new ones. "Enough already!" as Mud arrives. Squish squish: shall we add to the wet by crying over what we used to be able to do, even if it was stupid? We do regret that we had not been kinder and quieter. Others remind us. We try again because we tend to forget good advice in the face of the "reality" of daily living -- as we forget how long Hot lasted as we approach Snow again.

As in film, one season fades into another -- Mud with Snow, a touch of Hot with Mud. We do cherish a brief period this time of year -- the wondrous colors of quaking golden Aspen against green Pine, with a touch of white. Too soon all is as white as the color of our thinning hair. We wish that we could extend the period of Aspen in our mind by calling it Now. We vow Now to be kinder and quieter through the rest of the seasons no matter their names.

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Domenic Fuccillo is a retired Clinical Chaplain who lives in Littleton, Colorado and a regular contributor to the Pastoral Report.

A NOTE FROM THE EDITOR:The CPSP Communications Committee is pleased to present the first edition of cpspnewsnotes, a series of brief headlines about recent news items that are linked to in-depth articles. Readers are encouraged to skim the headlines and to click on the articles that interest them to learn more. We hope you enjoy reviewing and reading this first edition!-- Perry Miller, Editor, Pastoral Report and Chair, CPSP Communications Committee

In an effort to improve the certification experience, the CPSP Certification Committee has worked to make changes to the process that will help to support our certification candidates and organize the way we share information.

The most significant change in the certification process is the streamlining and merger of the forms that we used in the past, the Chapter Recommendation for Certification Form and the certification facesheet, into one form. The new forms are on the website at CPSP.ORG, under the Certification menu.

Our most recent edition of the Standards includes a review process for all Supervisors-in-Training, Training Supervisors-in-Training, and Training Supervisors. The revised forms include the required materials for these categories. Note that Supervisors-in-Training and Training Supervisors-in-Training will, in addition to the requirements at the Chapter level, be required to consult with the Certification Committee to determine readiness to begin training. The consultation with the Certification Committee will occur via Zoom video conferencing. Those seeking to be certified as a Training Supervisor would complete the certification process including the review with a Certification Review Panel at one of its scheduled reviews.

All documents and interaction regarding certification are located on the website at CPSP.org. All candidates and chapters are encouraged to review these resources well in advance of a candidate's certification process. It is the candidate's responsibility to know the steps involved in their process and it is the chapter's role to assist the candidate with ongoing consultation regarding the candidate's preparation for certification.

A centralized and shared Dropbox folder will still be utilized in the certification process, and candidates should be aware that their supporting documents should now be submitted as one document, a pdf, to their folder (similar to the submitting of an academic research paper). This is to help streamline the review process and to keep the files manageable for the review panels.

In addition to online certification forms and the centralizing of the Dropbox folders, members of the Certification Committee have recently completed the first CPSP Certification Manual, a resource manual for candidates, conveners, and Chapters. The committee has spent many hours reviewing documents, forms, and articles to provide this first addition of the manual.

As CPSP utilizes this process, updates our governance documents and forms, we will also update the manual. This is a working document. We hope you find the new manual helpful and we welcome your feedback.

Chaplaincy Alive! is a new podcast production by the CPSP Communications Committee, featuring the work and expertise of the members of CPSP, as well as distinguished members of the broader clinical pastoral community and beyond.

As strange as it might sound, the CPSP Communication Committee does not want CPSP to own this podcast as our very own. Equally, it is not to be a public relations promotional tool for CPSP. It is not in CPSP’s well being nor that of the wider clinical pastoral community to create a CPSP silo that might further separate the various clinical pastoral organizations and the valuable work and ministry of those under their umbrellas who offer care and counseling to the many who are disturbed in life and relationships.

We plan to work hard to make it a forum for all clinical pastoral organization and those in other fields such as the humanities and social sciences who have exciting ideas, creative visions, life stories, etc. that have the potential of advancing the whole clinical pastoral movement.”

Susan McDougal, CPE Supervisor at University of Arkansas for Medical Sciences, will be the host of Chaplaincy Alive! Krista Argiropolis provides the role of the show’s producer.

The first episode of Chaplaincy Alive! features four chaplains from Orlando, FL discussing their experience, thoughts, and emotions, as they provided response to the tragic shooting at a local night club, earlier this summer.

Chaplaincy Alive! host, Susan McDougal, says, “This interview highlights the work of CPSP chaplains who responded to the Orlando tragedy, the worst mass shooting in U.S. history. It is important for all of us who work in this field to hear them.”

As I prepare for a new group of CPE residents and interns, I pause for a moment in reflection upon the outgoing training group that has just completed a year of clinical pastoral training. I appreciate their struggles over the past year as they engaged the many challenges and opportunities afforded them in clinical pastoral training. In honor and with gratitude I wrote the following short poem in celebration of their engagement of each other in the dreaded clinical case study seminar.

Through a Glass DarklyForged by experience of confrontation and challengeShaped by critical reflected accountabilityDisarmed resistance yields to midwifed transformationFledgling self-awareness for the first time born!

1st Corinthians 13:12:For now we see only a reflection as in a mirror;
then we shall see face to face.
Now I know in part; then I shall know fully,
even as I am fully known.
(New International Version)

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George Hull, DirectorUniversity of Arkansas for Medical Sciences JHull@uams.edu

A member of our CPSP family achieved an extraordinary accomplishment this past Saturday. Asha Allen successfully swam across the English Channel. This she did in thirteen hours, 3 minutes, in Force 5 conditions!

Obviously Asha has a love of swimming and is extraordinarily talented. It takes a lot of courage and joy to engage in such an adventure. There is more to her story, however. What else drives her to embark upon such a journey, a journey that some would think impossible? It is her caring heart. I quote from her website,AshaSwims:

In 2014, Asha and her husband David Roth, working alongside local people, made a specific commitment to help support elderly widows in the village of San Pedro la Laguna, Guatemala, with their dietary and other basic subsistence needs. These are women who suffered greatly and lost much during a civil war that took the lives of hundreds of thousands, especially the men.

Her website provides further information about this human tragedy and about people who desperately need help.

I hope you will send Asha your congratulations, consider contributing to the cause for which she swims and offer good vibes to her supportive husband, David Roth.

David has held positions as a CPE Supervisor at Duke University Medical Center, as a pastoral counselor at Counseling Services, Inc. and at the Pastoral Care & Counseling Institute in Durham, NC. He also served for a decade as Director of the Pastoral Care & Counseling department at Alamance Regional Medical Center in Burlington NC. There he and a colleague developed the Alamance Institute for Pastoral Counseling, an AAPC accredited doctoral program in Pastoral Counseling working in conjunction with Graduate Theological Foundation. David has been a Diplomate in the College of Pastoral Supervision and Psychotherapy for fifteen years.